To explore the managements for intraoperative thrombosis in liver transplant patients complicated with portal vein thrombosis (PVT) and its efficacy.

Clinical data of 10 patients complicated with PVT who underwent liver transplantation between February 2018 and October 2018 in Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 3 female, aged 37-66 years old with a median age of 54 years old. PVT was classified based on Yerdel classification. Among them, 4 cases were classified as grade Ⅰ, 4 grade Ⅱ and 2 grade Ⅲ. The managements for intraoperative thrombosis were summarized and clinical efficacy was evaluated.

For patients with grade Ⅰ thrombosis, the thrombi were removed directly or treated by dissecting the portal vein trunk at the high end. According to the progression of thrombi, grade Ⅱ and Ⅲ thrombi were removed directly, or vascular anastomosis was performed after the removal. The large shunt vessels were ligated and dissected. After the operation, intravenous or subcutaneous injection of heparin was given for anticoagulation. The portal vein blood flow was monitored by ultrasound periodically after operation. During 6-month follow-up, postoperative ultrasound demonstrated normal portal vein blood flow in all patients. No portal vein-related complications, such as new PVT, stenosis and insufficient blood flow, occurred.

For patients complicated with PVT, assessment of range and severity of PVT should be performed before operation to obtain sufficient portal vein blood flow of the graft, and to design a precise surgical plan. PVT can be treated according to individual conditions to guarantee the well blood flow of portal vein and to reduce the postoperative complications.